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Berg AT, Baca CB, Rychlik K, Vickrey BG, Caplan R, Testa FM, Levy SR. Determinants of Social Outcomes in Adults With Childhood-onset Epilepsy. Pediatrics 2016; 137:peds.2015-3944. [PMID: 26983470 PMCID: PMC4811319 DOI: 10.1542/peds.2015-3944] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 01/20/2016] [Indexed: 11/24/2022] Open
Abstract
BACKGROUND Adults with childhood-onset epilepsy experience poorer adult social outcomes than their peers. The relative roles of seizures over time versus learning and psychiatric problems are unclear. METHODS We examined independent influences of psychiatric and learning disorders and of seizure course in 241 young adults (22-35 years old) with uncomplicated epilepsy in a longitudinal community-based cohort study. Social outcomes were ascertained throughout the study. A history of psychiatric and learning problems was ascertained ∼9 years after study entry. Seizure course was: "Excellent," no seizures after the first year, in complete remission at last contact (N = 95, 39%); "Good," seizures occurred 1 to 5 years after diagnosis, in complete remission at last contact (N = 56, 23%); "Fluctuating," more complicated trajectories, but never pharmacoresistant (N = 70, 29%); "Pharmacoresistant," long-term pharmacoresistant (N = 20, 8%). Multiple logistic regression was used to identify contributors to each social outcome. RESULTS Better seizure course predicted college completion, being either employed or pursuing a degree, and driving, but was not substantially associated with other social outcomes. Poorer seizure course was associated with a greater likelihood of having offspring, particularly in women without partners. Learning problems, psychiatric disorders, or both negatively influenced all but 2 of the social outcomes. CONCLUSIONS In young adults with uncomplicated epilepsy, the course of seizures contributed primarily to education, employment, and driving. A history of learning problems and psychiatric disorders adversely influenced most adult outcomes. These findings identify potential reasons for vocational and social difficulties encountered by young adults with childhood epilepsy and areas to target for counseling and transition planning.
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Affiliation(s)
- Anne T. Berg
- Epilepsy Center and,Department of Pediatrics, Northwestern Feinberg School of Medicine, Chicago, Illinois
| | - Christine B. Baca
- Department of Neurology and,Department of Neurology, VA Greater Los Angeles Health Care System, Los Angeles, California
| | - Karen Rychlik
- Biostatistics Research Core, Stanley Manne Children’s Research Institute, Ann & Robert H. Lurie Children’s Hospital of Chicago, Chicago, Illinois
| | - Barbara G. Vickrey
- Department of Neurology, Icahn School of Medicine, New York, New York; and
| | - Rochelle Caplan
- David Geffen School of Medicine, Semel Institute of Neuroscience and Human Behavior, University of California Los Angeles, Los Angeles, California
| | - Francine M. Testa
- Departments of Neurology and,Pediatrics, Yale School of Medicine, New Haven, Connecticut
| | - Susan R. Levy
- Departments of Neurology and,Pediatrics, Yale School of Medicine, New Haven, Connecticut
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152
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Arcaro J, Ma J, Chu L, Kuo M, Mirsattari SM, Stan Leung L. The hippocampus participates in a pharmacological rat model of absence seizures. Epilepsy Res 2016; 120:79-90. [PMID: 26773250 PMCID: PMC4942264 DOI: 10.1016/j.eplepsyres.2015.12.007] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2015] [Revised: 11/05/2015] [Accepted: 12/12/2015] [Indexed: 11/20/2022]
Abstract
OBJECTIVE Using the gamma-butyrolactone (GBL) model of absence seizures in Long-Evans rats, this study investigated if 2.5-6 Hz paroxysmal discharges (PDs) induced by GBL were synchronized among the thalamocortical system and the hippocampus, and whether inactivation of the hippocampus affected PDs. METHODS Local field potentials were recorded by chronically implanted depth electrodes in the neocortex (frontal, parietal, visual), ventrolateral thalamus and dorsal hippocampal CA1 area. In separate experiments, multiple unit recordings were made at the hippocampal CA1 pyramidal cell layer, or the mid-septotemporal hippocampus was inactivated by local infusion of GABAA receptor agonist muscimol. RESULTS As PDs developed following GBL injection, coherence of local field potentials at 2.5-6 Hz increased between the hippocampus and thalamus, and between the hippocampus and the neocortex. Hippocampal theta rhythm was disrupted when GBL induced immobility in the rats. The probability of hippocampal multiple unit firing significantly increased at 40-80 ms prior to the negative peak of thalamic PDs. Coherence between hippocampal multiple unit activity and thalamic field potentials at 2.5-6 Hz was significantly increased after GBL injection. Muscimol infusion to inactivate the mid-septotemporal hippocampus, as compared to saline infusion, significantly decreased the peak frequency of the PDs induced by GBL, decreased 30-120 Hz hippocampal gamma power, and hastened the transition of PDs to 1-2 Hz slow waves. SIGNIFICANCE During GBL induced 2.5-6 Hz PDs, a hallmark of absence seizure, increased synchronization between the hippocampus and the thalamocortical network was indicated by frequency and temporal correlation analysis. These results suggest that the hippocampus was entrained by thalamocortical activity in the present model of absence seizures. Prolonged synchronization of the hippocampus may result in synaptic alterations that may explain the cognitive and memory deficits in some patients with absence seizures and absence status epilepticus.
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Affiliation(s)
- Justin Arcaro
- Graduate Program in Neuroscience, University of Western Ontario, London, Ontario, Canada; Department of Physiology and Pharmacology, University of Western Ontario, London, Ontario, Canada; Department of Clinical Neurological Sciences, University of Western Ontario, London, Ontario, Canada.
| | - Jingyi Ma
- Department of Physiology and Pharmacology, University of Western Ontario, London, Ontario, Canada.
| | - Liangwei Chu
- Department of Physiology and Pharmacology, University of Western Ontario, London, Ontario, Canada.
| | - MinChing Kuo
- Department of Physiology and Pharmacology, University of Western Ontario, London, Ontario, Canada.
| | - Seyed M Mirsattari
- Graduate Program in Neuroscience, University of Western Ontario, London, Ontario, Canada; Department of Clinical Neurological Sciences, University of Western Ontario, London, Ontario, Canada.
| | - L Stan Leung
- Graduate Program in Neuroscience, University of Western Ontario, London, Ontario, Canada; Department of Physiology and Pharmacology, University of Western Ontario, London, Ontario, Canada.
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153
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Neuropsychological impairment in childhood absence epilepsy: Review of the literature. J Neurol Sci 2015; 359:59-66. [DOI: 10.1016/j.jns.2015.10.035] [Citation(s) in RCA: 46] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2015] [Revised: 10/14/2015] [Accepted: 10/15/2015] [Indexed: 11/22/2022]
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154
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Vega YH, Smith A, Cockerill H, Tang S, Agirre-Arrizubieta Z, Goyal S, Pina M, Akman CI, Jolleff N, McGinnity C, Gomez K, Gupta R, Hughes E, Jackman J, McCormick D, Oren C, Scott D, Taylor J, Trounce J, Clarke T, Kugler S, Mandelbaum DE, McGoldrick P, Wolf S, Strug LJ, Pal DK. Risk factors for reading disability in families with rolandic epilepsy. Epilepsy Behav 2015; 53:174-9. [PMID: 26580214 PMCID: PMC4719157 DOI: 10.1016/j.yebeh.2015.10.016] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/08/2015] [Revised: 10/14/2015] [Accepted: 10/16/2015] [Indexed: 11/25/2022]
Abstract
OBJECTIVE The high prevalence and impact of neurodevelopmental comorbidities in childhood epilepsy are now well known, as are the increased risks and familial aggregation of reading disability (RD) and speech sound disorder (SSD) in rolandic epilepsy (RE). The risk factors for RD in the general population include male sex, SSD, and ADHD, but it is not known if these are the same in RE or whether there is a contributory role of seizure and treatment-related variables. METHODS An observational study of 108 probands with RE (age range: 3.6-22 years) and their 159 siblings (age range: 1-29 years; 83 with EEG data) were singly ascertained in the US or UK through a proband affected by RE. We used a nested case-control design, multiple logistic regression, and generalized estimating equations to test the hypothesis of an association between RD and seizure variables or antiepileptic drug treatment in RE; we also assessed an association between EEG focal sharp waves and RD in siblings. RESULTS Reading disability was reported in 42% of probands and 22% of siblings. Among probands, RD was strongly associated with a history of SSD (OR: 9.64, 95% CI: 2.45-37.21), ADHD symptoms (OR: 10.31, 95% CI: 2.15-49.44), and male sex (OR: 3.62, 95% CI: 1.11-11.75) but not with seizure or treatment variables. Among siblings, RD was independently associated only with SSD (OR: 4.30, 95% CI: 1.42-13.0) and not with the presence of interictal EEG focal sharp waves. SIGNIFICANCE The principal risk factors for RD in RE are SSD, ADHD, and male sex, the same risk factors as for RD without epilepsy. Seizure or treatment variables do not appear to be important risk factors for RD in probands with RE, and there was no evidence to support interictal EEG focal sharp waves as a risk factor for RD in siblings. Future studies should focus on the precise neuropsychological characterization of RD in families with RE and on the effectiveness of standard oral-language and reading interventions.
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Affiliation(s)
| | | | | | - Shan Tang
- King’s College London, UK,King’s Health Partners, London, UK
| | | | | | | | - Cigdem I Akman
- Department of Neurology, Columbia University, New York, USA
| | - Nicola Jolleff
- East Kent Hospitals University NHS Foundation Trust, Canterbury, UK
| | | | | | | | | | | | | | | | | | | | | | - Tara Clarke
- Department of Epidemiology, Columbia University, New York, USA
| | - Steven Kugler
- Children’s Hospital of Philadelphia and University of Pennsylvania School of Medicine, PA, USA
| | - David E Mandelbaum
- Hasbro Children’s Hospital and the Warren Alpert Medical School of Brown University, Providence, RI, USA
| | | | | | - Lisa J Strug
- Program in Genetics and Genome Biology, The Hospital for Sick Children, Toronto; Canada,Dalla Lana School of Public Health, University of Toronto, Canada
| | - Deb K Pal
- King's College London, UK; King's Health Partners, London, UK.
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155
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Franzoni E, Matricardi S, Di Pisa V, Capovilla G, Romeo A, Tozzi E, Pruna D, Salerno GG, Zamponi N, Accorsi P, Giordano L, Coppola G, Cerminara C, Curatolo P, Nicita F, Spalice A, Grosso S, Pavone P, Striano P, Parisi P, Boni A, Gobbi G, Carotenuto M, Esposito M, Cottone C, Verrotti A. Refractory absence seizures: An Italian multicenter retrospective study. Eur J Paediatr Neurol 2015; 19:660-4. [PMID: 26239083 DOI: 10.1016/j.ejpn.2015.07.008] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/27/2014] [Revised: 06/30/2015] [Accepted: 07/07/2015] [Indexed: 11/29/2022]
Abstract
BACKGROUND To evaluate evidence and prognosis of refractory cases of absence seizures. METHODS Subjects with refractory absence seizures were identified retrospectively in 17 Italian epilepsy pediatrics Centers. We analyzed age at onset, family history, presence of myoclonic components, seizure frequency, treatment with antiepileptic drugs (AEDs), interictal electroencephalography (EEG) and neuropsychological assessment. Two subgroups were identified: one with patients with current absence seizures and another with patients that had become seizure free with or without AED treatment. The chi-square test was applied. RESULTS A total of 92 subjects with drug-resistant absence seizures were analyzed. 45 subjects still show absence seizures (49%) and the other 47 became seizure free (51%) after a period of drug-resistance. The statistical analysis between these two groups showed no correlation between age of onset, family history and abnormalities at interictal EEG. Statistically significant differences were observed with regard to the number of AEDs used and intellectual disability. CONCLUSION Typical absence epilepsy classifiable as Childhood Absence Epilepsy could not be considered so "benign", as suggested in literature. A longer duration of disease and a higher frequency of seizure seem to be correlated with a higher presence of cognitive impairment. No significant risk factor was observed to allow the faster and better recognition of patients with worse prognosis.
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Affiliation(s)
- Emilio Franzoni
- Child Neuropsychiatry Unit, Sant'Orsola-Malpighi Hospital, University of Bologna, Bologna, Italy.
| | - Sara Matricardi
- Department of Pediatrics, University of Chieti, Chieti, Italy
| | - Veronica Di Pisa
- Child Neuropsychiatry Unit, Sant'Orsola-Malpighi Hospital, University of Bologna, Bologna, Italy
| | | | - Antonino Romeo
- Epilepsy Center, Department of Child Neuropsychiatry and Neurophysiology, Fatebenefratelli and Oftalmico Hospital, Milan, Italy
| | - Elisabetta Tozzi
- Department of Child Neuropsychiatry, University of L'Aquila, L'Aquila, Italy
| | - Dario Pruna
- Child and Adolescent Neuropsychiatry, University of Cagliari, Cagliari, Italy
| | | | - Nelia Zamponi
- Pediatric Neurology Department, Polytechnic University of the Marche Region, Ancona, Italy
| | | | - Lucio Giordano
- Child Neuropsychiatric Unit, Civile Hospital, Brescia, Italy
| | - Giangennaro Coppola
- Department of Child and Adolescent Neuropsychiatric, Medical School, University of Salerno, Salerno, Italy
| | - Caterina Cerminara
- Department of Neurosciences, Pediatric Neurology Unit, Tor Vergata University, Roma, Italy
| | - Paolo Curatolo
- Department of Neurosciences, Pediatric Neurology Unit, Tor Vergata University, Roma, Italy
| | - Francesco Nicita
- Department of Pediatrics, Division of Child Neurology, Sapienza, University of Rome, Rome, Italy
| | - Alberto Spalice
- Department of Pediatrics, Division of Child Neurology, Sapienza, University of Rome, Rome, Italy
| | - Salvatore Grosso
- Department of Pediatrics, Pediatric Neurology Unit, S. Maria Alle Scotte Hospital, University of Siena, Italy
| | - Piero Pavone
- Department of Pediatrics and Pediatrics Emergency, University Hospital Policlinico Vittorio Emanuele, Catania, Italy
| | - Pasquale Striano
- Pediatric Neurology and Muscular Diseases Unit, Department of Neurosciences, Rehabilitation, Opthalmology, Genetics and Maternal and Child Health, University of Genova, G. Gaslini Institute, Genova, Italy
| | - Pasquale Parisi
- Neuroscience, Mental Health and Sensory Organs Department, Child Neurology, Headache Pediatric Center, Pediatric Sleep Disorder, Sapienza, University of Rome, Rome, Italy
| | - Antonella Boni
- IRRCS, The Institute of Neurological Sciences of Bologna, Child Neurology Unit, Bologna, Italy
| | - Giuseppe Gobbi
- IRRCS, The Institute of Neurological Sciences of Bologna, Child Neurology Unit, Bologna, Italy
| | - Marco Carotenuto
- Clinic of Child and Adolescent Neuropsychiatry, Department of Mental Health, Physical and Preventive Medicine, Second University of Naples, Naples, Italy
| | - Maria Esposito
- Clinic of Child and Adolescent Neuropsychiatry, Department of Mental Health, Physical and Preventive Medicine, Second University of Naples, Naples, Italy
| | - Carlo Cottone
- Child Neuropsychiatry Unit, Sant'Orsola-Malpighi Hospital, University of Bologna, Bologna, Italy
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156
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Tosun D, Siddarth P, Levitt J, Caplan R. Cortical thickness and sulcal depth: insights on development and psychopathology in paediatric epilepsy. BJPsych Open 2015; 1:129-135. [PMID: 27703737 PMCID: PMC4995587 DOI: 10.1192/bjpo.bp.115.001719] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/03/2015] [Revised: 08/31/2015] [Accepted: 10/01/2015] [Indexed: 01/07/2023] Open
Abstract
BACKGROUND The relationship between cortical thickness (CThick) and sulcal depth (SDepth) changes across brain regions during development. Epilepsy youth have CThick and SDepth abnormalities and prevalent psychiatric disorders. AIMS This study compared the CThick-SDepth relationship in children with focal epilepsy with typically developing children (TDC) and the role played by seizure and psychopathology variables. METHOD A surface-based, computational high-resolution three-dimesional (3D) magnetic resonance image analytic technique compared regional CThick-SDepth relationships in 42 participants with focal epilepsy and 46 TDC (6-16 years) imaged in a 1.5 Tesla scanner. Psychiatric interviews administered to each participant yielded psychiatric diagnoses. Parents provided seizure-related information. RESULTS The TDC group alone demonstrated a significant negative medial fronto-orbital CThick-SDepth correlation. Focal epilepsy participants with but not without psychiatric diagnoses showed significant positive pre-central and post-central CThick-SDepth associations not found in TDC. Although the history of prolonged seizures was significantly associated with the post-central CThick-SDepth correlation, it was unrelated to the presence/absence of psychiatric diagnoses. CONCLUSIONS Abnormal CThick-SDepth pre-central and post-central associations might be a psychopathology biomarker in paediatric focal epilepsy. DECLARATION INTEREST None. COPYRIGHT AND USAGE © 2015 The Royal College of Psychiatrists. This is an open access article distributed under the terms of the Creative Commons Non-Commercial, No Derivatives (CC BY-NC-ND) licence.
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Affiliation(s)
- Duygu Tosun
- , PhD, Department of Radiology and Biomedical Imaging, University of California - San Francisco, California, and Center for Imaging of Neurodegenerative Diseases, San Francisco Veterans Affairs Medical Center, San Francisco, California, USA
| | - Prabha Siddarth
- , PhD, Department of Psychiatry, Semel Institute for Neuroscience and Human Behavior, UCLA David Geffen School of Medicine, Los Angeles, California, USA
| | - Jennifer Levitt
- , MD, Department of Psychiatry, Semel Institute for Neuroscience and Human Behavior, UCLA David Geffen School of Medicine, Los Angeles, California, USA
| | - Rochelle Caplan
- , MD, Department of Psychiatry, Semel Institute for Neuroscience and Human Behavior, UCLA David Geffen School of Medicine, Los Angeles, California, USA
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157
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Affiliation(s)
- Rochelle Caplan
- Department of Psychiatry, Semel Institute for Neuroscience and Human Behavior, UCLA, Los Angeles, California, U.S.A
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158
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Lenck-Santini PP, Scott RC. Mechanisms Responsible for Cognitive Impairment in Epilepsy. Cold Spring Harb Perspect Med 2015; 5:cshperspect.a022772. [PMID: 26337111 DOI: 10.1101/cshperspect.a022772] [Citation(s) in RCA: 65] [Impact Index Per Article: 7.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
Epilepsy is often associated with cognitive and behavioral impairments that can have profound impact on the quality of life of patients. Although the mechanisms of cognitive impairment are not completely understood, we make an attempt to describe, from a systems perspective, how information processing is affected in epilepsy disorders. The aim of this review is to (1) define the nature of cognitive deficits associated with epilepsy, (2) review fundamental systems-level mechanisms underlying information processing, and (3) describe how information processing is dysfunctional in epilepsy and investigate the relative contributions of etiology, seizures, and interictal discharges (IDs). We conclude that these mechanisms are likely to be important and deserve more detailed scrutiny in the future.
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Affiliation(s)
| | - Rodney C Scott
- Institute of Child Health, University College of London, London WC1N 3JH, United Kingdom
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159
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Zilli T, Zanini S, Conte S, Borgatti R, Urgesi C. Neuropsychological assessment of children with epilepsy and average intelligence using NEPSY II. J Clin Exp Neuropsychol 2015; 37:1036-51. [DOI: 10.1080/13803395.2015.1076380] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/11/2023]
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160
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Gray and White Matter Volumes and Cognitive Dysfunction in Drug-Naïve Newly Diagnosed Pediatric Epilepsy. BIOMED RESEARCH INTERNATIONAL 2015; 2015:923861. [PMID: 26417604 PMCID: PMC4568349 DOI: 10.1155/2015/923861] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/27/2014] [Revised: 04/20/2015] [Accepted: 06/21/2015] [Indexed: 12/02/2022]
Abstract
Epilepsy patients often have cognitive dysfunction even at early stages of disease. We investigated the relationship between structural findings and neuropsychological status in drug-naïve newly diagnosed pediatric epilepsy patients. Thirty newly diagnosed pediatric epilepsy patients and 25 healthy control subjects aged 7~16 years were enrolled, who were assessed by the Korean version of the Wechsler Intelligence Scale for Children (K-WISC-III), the Stroop test, and the trail making test (TMT). Optimized voxel-based morphometry (VBM) was performed for both Gray Matter (GM) and White Matter (WM) volumes. Lower performance levels of verbal intelligence quotient, freedom from distractibility, and executive function were observed in epilepsy group. Interestingly, poor performance in these cognitive subdomains was correlated with regional VBM findings involving both GM and WM volumes, but with different patterns between groups. GM volumes revealed clear differences predominantly in the bilateral frontal regions. These findings indicate that certain cognitive functions may be affected in the early stage of epilepsy, not related to the long-standing epilepsy or medication, but more related to the neurocognitive developmental process in this age. Epilepsy can lead to neuroanatomical alterations in both GM and WM, which may affect cognitive functions, during early stages even before commencement of AED medication.
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161
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Seizure and Psychosocial Outcomes of Childhood and Juvenile Onset Generalized Epilepsies: Wolf in Sheep's Clothing, or Well-Dressed Wolf? Epilepsy Curr 2015; 15:114-7. [PMID: 26316843 DOI: 10.5698/1535-7597-15.3.114] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Abstract
Studies of generalized electroclinical syndromes can provide guidance regarding long-term seizure, cognitive, and psychosocial outcomes. Childhood absence epilepsy, juvenile absence epilepsy, juvenile myoclonic epilepsy, and idiopathic generalized epilepsy with generalized tonic-clonic seizures alone are electroclinical syndromes typically associated with normal intellect and good response to antiseizure medications. However, studies have demonstrated significantly poorer psychosocial outcomes than expected for these syndromes, regardless of seizure control. Potential causes for this include underlying abnormalities in social skills, social stigma, and underlying abnormalities in brain development and maturation.
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162
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Depaulis A, David O, Charpier S. The genetic absence epilepsy rat from Strasbourg as a model to decipher the neuronal and network mechanisms of generalized idiopathic epilepsies. J Neurosci Methods 2015; 260:159-74. [PMID: 26068173 DOI: 10.1016/j.jneumeth.2015.05.022] [Citation(s) in RCA: 86] [Impact Index Per Article: 9.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2015] [Revised: 05/28/2015] [Accepted: 05/28/2015] [Indexed: 12/31/2022]
Abstract
First characterized in 1982, the genetic absence epilepsy rat from Strasbourg (GAERS) has emerged as an animal model highly reminiscent of a specific form of idiopathic generalized epilepsy. Both its electrophysiological (spike-and-wave discharges) and behavioral (behavioral arrest) features fit well with those observed in human patients with typical absence epilepsy and required by clinicians for diagnostic purposes. In addition, its sensitivity to antiepileptic drugs closely matches what has been described in the clinic, making this model one of the most predictive. Here, we report how the GAERS, thanks to its spontaneous, highly recurrent and easily recognizable seizures on electroencephalographic recordings, allows to address several key-questions about the pathophysiology and genetics of absence epilepsy. In particular, it offers the unique possibility to explore simultaneously the neural circuits involved in the generation of seizures at different levels of integration, using multiscale methodologies, from intracellular recording to functional magnetic resonance imaging. In addition, it has recently allowed to perform proofs of concept for innovative therapeutic strategies such as responsive deep brain stimulation or synchrotron-generated irradiation based radiosurgery.
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Affiliation(s)
- Antoine Depaulis
- Inserm, U836, F-38000 Grenoble, France; Univ. Grenoble Alpes, Grenoble Institut des Neurosciences, F-38000 Grenoble, France; CHU de Grenoble, Hôpital Michallon, F-38000 Grenoble, France.
| | - Olivier David
- Inserm, U836, F-38000 Grenoble, France; Univ. Grenoble Alpes, Grenoble Institut des Neurosciences, F-38000 Grenoble, France
| | - Stéphane Charpier
- Brain and Spine Institute, Pitié-Salpêtrière Hospital, Paris, France; Pierre and Marie Curie University, Paris, France
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163
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Li Q, Cao W, Liao X, Chen Z, Yang T, Gong Q, Zhou D, Luo C, Yao D. Altered resting state functional network connectivity in children absence epilepsy. J Neurol Sci 2015; 354:79-85. [PMID: 25982500 DOI: 10.1016/j.jns.2015.04.054] [Citation(s) in RCA: 50] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2015] [Revised: 04/09/2015] [Accepted: 04/30/2015] [Indexed: 02/05/2023]
Abstract
Altered functional connectivity has been associated with the influence of epileptic activity. Abnormalities in connectivity, particularly in dorsal attention (DAN), salience (SN) and default mode (DMN) networks, might contribute to the loss of consciousness during seizures and cognitive deficits in patients with children absence epilepsy (CAE). The objective of the present study was to identify whether the functional network connectivity (FNC) is changed between patients with CAE and healthy controls. Using independent component analysis, twelve resting state networks (RSNs) were identified in resting state functional magnetic resonance imaging data sets in eighteen CAE patients and twenty-one healthy controls. Analyses of the group differences in FNC strength were conducted, controlling for age and gender effects. The findings showed that some functional networks were clustered into two subgroups, correlated within subgroups and antagonized with each other. Compared with the controls, patients with CAE demonstrated abnormal FNC strength among three networks: DMN, DAN and SN. In addition, the antagonism of two subgroups was altered. These results might reflect the underlying neuronal functional impairment or altered integration among these RSNs in CAE, suggesting that the abnormal functional connectivity is likely to imply the pathological mechanism associated with the accumulative influence of epileptic activity. These findings contribute to the understanding of the behavior abnormality in CAE, such as disturbed executive and attentional functions and the loss of consciousness during absence seizures.
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Affiliation(s)
- Qifu Li
- Department of Neurology, The Affiliated Hospital of Hainan Medical College, Haikou, China
| | - Weifang Cao
- Key Laboratory for NeuroInformation of Ministry of Education, Center for Information in BioMedicine, High-Field Magnetic Resonance Brain Imaging Key Laboratory of Sichuan Province, University of Electronic Science and Technology of China, Chengdu 610054, China; Department of Radiology, Taishan Medical University, Taian 271016, China
| | - Xiaoping Liao
- Department of Neurology, The Affiliated Hospital of Hainan Medical College, Haikou, China
| | - Zhibin Chen
- Department of Neurology, The Affiliated Hospital of Hainan Medical College, Haikou, China
| | - Tianhua Yang
- Department of Neurology, West China Hospital of Sichuan University, Chengdu 610041, China
| | - Qiyong Gong
- Huaxi MR Research Center (HMRRC), Department of Radiology, West China Hospital of Sichuan University, Chengdu 610041, China
| | - Dong Zhou
- Department of Neurology, West China Hospital of Sichuan University, Chengdu 610041, China.
| | - Cheng Luo
- Key Laboratory for NeuroInformation of Ministry of Education, Center for Information in BioMedicine, High-Field Magnetic Resonance Brain Imaging Key Laboratory of Sichuan Province, University of Electronic Science and Technology of China, Chengdu 610054, China.
| | - Dezhong Yao
- Key Laboratory for NeuroInformation of Ministry of Education, Center for Information in BioMedicine, High-Field Magnetic Resonance Brain Imaging Key Laboratory of Sichuan Province, University of Electronic Science and Technology of China, Chengdu 610054, China
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164
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Jokinen TS, Tiira K, Metsähonkala L, Seppälä EH, Hielm-Björkman A, Lohi H, Laitinen-Vapaavuori O. Behavioral Abnormalities in Lagotto Romagnolo Dogs with a History of Benign Familial Juvenile Epilepsy: A Long-Term Follow-Up Study. J Vet Intern Med 2015; 29:1081-7. [PMID: 25945683 PMCID: PMC4895370 DOI: 10.1111/jvim.12611] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2014] [Revised: 03/25/2015] [Accepted: 04/14/2015] [Indexed: 11/28/2022] Open
Abstract
Background Lagotto Romagnolo (LR) dogs with benign juvenile epilepsy syndrome often experience spontaneous remission of seizures. The long‐term outcome in these dogs currently is unknown. In humans, behavioral and psychiatric comorbidities have been reported in pediatric and adult‐onset epilepsies. Hypothesis/Objectives The objectives of this study were to investigate possible neurobehavioral comorbidities in LR with a history of benign familial juvenile epilepsy (BFJE) and to assess the occurrence of seizures after the remission of seizures in puppyhood. Animals A total of 25 LR with a history of BFJE and 91 control dogs of the same breed. Methods Owners of the LR dogs in the BFJE and control groups completed an online questionnaire about each dog's activity, impulsivity, and inattention. Principal component analysis (PCA) served to extract behavioral factors from the data. We then compared the scores of these factors between the 2 groups in a retrospective case–control study. We also interviewed all dog owners in the BFJE group by telephone to inquire specifically about possible seizures or other neurological problems after remission of seizures as a puppy. Results Lagotto Romagnolo dogs with BFJE showed significantly higher scores on the factors Inattention and Excitability/Impulsivity than did the control group (P = .003; P = .021, respectively). Only 1 of the 25 BFJE LR exhibited seizures after remission of epilepsy in puppyhood. Conclusions and Clinical Importance Although the long‐term seizure outcome in BFJE LR seems to be good, the dogs exhibit behavioral abnormalities resembling attention deficit hyperactivity disorder (ADHD) in humans, thus suggesting neurobehavioral comorbidities with epilepsy.
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Affiliation(s)
- T S Jokinen
- Department of Equine and Small Animal Medicine, University of Helsinki, Helsinki, Finland
| | - K Tiira
- Department of Veterinary Biosciences and Research Programs Unit, Molecular Neurology, University of Helsinki, Helsinki, Finland.,Department of Molecular Genetics, Folkhälsan Institute of Genetics, Helsinki, Finland
| | - L Metsähonkala
- Epilepsy Unit, Hospital for Children and Adolescents, Helsinki, Finland
| | - E H Seppälä
- Department of Veterinary Biosciences and Research Programs Unit, Molecular Neurology, University of Helsinki, Helsinki, Finland.,Department of Molecular Genetics, Folkhälsan Institute of Genetics, Helsinki, Finland
| | - A Hielm-Björkman
- Department of Equine and Small Animal Medicine, University of Helsinki, Helsinki, Finland
| | - H Lohi
- Department of Veterinary Biosciences and Research Programs Unit, Molecular Neurology, University of Helsinki, Helsinki, Finland.,Department of Molecular Genetics, Folkhälsan Institute of Genetics, Helsinki, Finland
| | - O Laitinen-Vapaavuori
- Department of Equine and Small Animal Medicine, University of Helsinki, Helsinki, Finland
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165
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Rizou I, De Gucht V, Papavasiliou A, Maes S. Illness perceptions determine psychological distress and quality of life in youngsters with epilepsy. Epilepsy Behav 2015; 46:144-50. [PMID: 25900225 DOI: 10.1016/j.yebeh.2015.03.022] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/22/2015] [Revised: 03/19/2015] [Accepted: 03/21/2015] [Indexed: 10/23/2022]
Abstract
The aim of this cross-sectional study was to explore the extent to which gender, epilepsy severity, and self-regulation concepts (illness perceptions, autonomous treatment regulation, perceived autonomy support by parents) predict psychological distress and quality of life (QoL) in young patients with epilepsy. Structured interviews were conducted in 100 patients (Mage=13.9, SD=2.21, 41% girls), and data were analyzed by means of multiple hierarchical regression analyses. Seizures of most patients (91%) were well controlled by antiepileptics, 3% of the patients had infrequent seizures, and seizures in 6% were pharmacoresistant. At a multivariate level, it appeared that youngsters with epilepsy who expect that their disease will last for a long time, who believe that they have less personal control over their illness, and who expect the illness to have a high emotional impact reported higher levels of distress. In addition, a better QoL was reported by youngsters who believed that treatment did not control their illness and who thought that their epilepsy would not affect them emotionally. Findings indicate the importance of illness perceptions, and it is suggested that they should be targeted in future interventions in youngsters with epilepsy.
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Affiliation(s)
- Ioanna Rizou
- Child Psychiatry Department, Mental Health Center of General Hospital of Athens "G. Gennimatas", Athens, Greece.
| | - Veronique De Gucht
- Health, Medical and Neuropsychology Department, Leiden University, Leiden, The Netherlands
| | | | - Stan Maes
- Health, Medical and Neuropsychology Department, Leiden University, Leiden, The Netherlands
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166
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Jafarian M, Karimzadeh F, Alipour F, Attari F, Lotfinia AA, Speckmann EJ, Zarrindast MR, Gorji A. Cognitive impairments and neuronal injury in different brain regions of a genetic rat model of absence epilepsy. Neuroscience 2015; 298:161-70. [PMID: 25907443 DOI: 10.1016/j.neuroscience.2015.04.033] [Citation(s) in RCA: 37] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2015] [Revised: 03/26/2015] [Accepted: 04/14/2015] [Indexed: 11/30/2022]
Abstract
Growing numbers of evidence indicate that cognitive impairments are part of clinical profile of childhood absence epilepsy. Little is known on neuropathological changes accompanied by cognitive deficits in absence epilepsy. The aim of the present study was to investigate age-dependent neuropathological changes accompanied by learning and memory impairments in Wistar Albino Glaxo from Rijswijk (WAG/Rij) rat model of absence epilepsy. Experimental groups were divided into four groups of six rats of both WAG/Rij and Wistar strains with 2 and 6 months of age. The learning and memory performances were assessed using passive avoidance paradigm and neuropathological alterations were investigated by the evaluation of the number of dark neurons and apoptotic cells as well as the expression of caspase-3 in the neocortex, the hippocampus, and different regions of the thalamus. Results revealed a decline in learning and spatial memory of 6-month-old WAG/Rij rats compared to age-matched Wistar rats as well as 2-month-old WAG/Rij and Wistar rats. The mean number of dark neurons was significantly higher in the hippocampal CA1 and CA3 areas as well as in the laterodorsal, centromedial, and reticular thalamic nuclei and the somatosensory cortex of 6-month-old WAG/Rij rats. In addition, a higher number of apoptotic cells as well as a higher expression of caspase-3 was observed in the hippocampal CA1 and CA3 regions, the laterodorsal thalamic nucleus, and the somatosensory cortex of 6-month-old WAG/Rij rats compared to other animal groups. These results indicate significant enhancement of neuronal damage and cell death accompanied by memory deficits after seizure attacks in a rat model of absence epilepsy. Seizure-induced neuronal injury and death may underlie cognitive impairments in absence epilepsy.
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Affiliation(s)
- M Jafarian
- School of Advanced Technologies in Medicine, Tehran University of Medical Sciences, Tehran, Iran; Shefa Neuroscience Research Centre, Khatam Alanbia Hospital, Tehran, Iran
| | - F Karimzadeh
- Shefa Neuroscience Research Centre, Khatam Alanbia Hospital, Tehran, Iran
| | - F Alipour
- Shefa Neuroscience Research Centre, Khatam Alanbia Hospital, Tehran, Iran
| | - F Attari
- Shefa Neuroscience Research Centre, Khatam Alanbia Hospital, Tehran, Iran
| | - A A Lotfinia
- Shefa Neuroscience Research Centre, Khatam Alanbia Hospital, Tehran, Iran
| | - E-J Speckmann
- Epilepsy Research Center, Klinik für Neurochirurgie, Department of Neurology, Institute of Neurophysiology, Westfälische Wilhelms-Universität Münster, Münster, Germany
| | - M-R Zarrindast
- School of Advanced Technologies in Medicine, Tehran University of Medical Sciences, Tehran, Iran.
| | - A Gorji
- Shefa Neuroscience Research Centre, Khatam Alanbia Hospital, Tehran, Iran; Epilepsy Research Center, Klinik für Neurochirurgie, Department of Neurology, Institute of Neurophysiology, Westfälische Wilhelms-Universität Münster, Münster, Germany.
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167
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Curwood EK, Pedersen M, Carney PW, Berg AT, Abbott DF, Jackson GD. Abnormal cortical thickness connectivity persists in childhood absence epilepsy. Ann Clin Transl Neurol 2015; 2:456-64. [PMID: 26000319 PMCID: PMC4435701 DOI: 10.1002/acn3.178] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2014] [Accepted: 01/04/2015] [Indexed: 02/01/2023] Open
Abstract
Objective Childhood absence epilepsy (CAE) is a childhood-onset generalized epilepsy. Recent fMRI studies have suggested that frontal cortex activity occurs before thalamic involvement in epileptic discharges suggesting that frontal cortex may play an important role in childhood absence seizures. Neurocognitive deficits can persist after resolution of the epilepsy. We investigate whether structural connectivity changes are present in the brains of CAE patients in young adulthood. Methods Cortical thickness measurements were obtained for 30 subjects with CAE (mean age 21 ± 2 years) and 56 healthy controls (mean age 24 ± 4) and regressed for age, sex, and total intracranial volume (TIV). Structural connectivity was evaluated by measuring the correlation between average cortical thicknesses in 915 regions over the brain. Maps of connectivity strength were then obtained for both groups. Results When compared to controls, the CAE group shows overall increased “connectivity” with focal increased connection strength in anterior regions including; the anterior cingulate and the insula and superior temporal gyrus bilaterally; the right orbito-frontal and supramarginal regions; and the left entorhinal cortex. Decreased connection strength in the CAE group was found in the left occipital lobe, with a similar trend in right occipital lobe. Interpretation Brains in young adults whose CAE was resolved had abnormal structural connectivity. Our findings suggest that frontal regions correlate most with cortical thickness throughout the brain in CAE patients, whereas occipital regions correlate most in well matched normal controls. We interpret this as evidence of a developmental difference in CAE that emphasizes these frontal lobe regions, perhaps driven by frontal lobe epileptiform activity.
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Affiliation(s)
- Evan K Curwood
- The Florey Institute of Neuroscience and Mental Health Austin Campus, Heidelberg, Victoria, Australia
| | - Mangor Pedersen
- Florey Department of Neuroscience and Mental Health, The University of Melbourne Heidelberg, Victoria, Australia
| | - Patrick W Carney
- The Florey Institute of Neuroscience and Mental Health Austin Campus, Heidelberg, Victoria, Australia ; Department of Medicine, The University of Melbourne Parkville, Victoria, Australia
| | - Anne T Berg
- Epilepsy Center, Ann and Robert H. Lurie Children's Hospital of Chicago Chicago, Illinois
| | - David F Abbott
- The Florey Institute of Neuroscience and Mental Health Austin Campus, Heidelberg, Victoria, Australia ; Florey Department of Neuroscience and Mental Health, The University of Melbourne Heidelberg, Victoria, Australia ; Department of Medicine, The University of Melbourne Parkville, Victoria, Australia
| | - Graeme D Jackson
- The Florey Institute of Neuroscience and Mental Health Austin Campus, Heidelberg, Victoria, Australia ; Florey Department of Neuroscience and Mental Health, The University of Melbourne Heidelberg, Victoria, Australia ; Department of Medicine, The University of Melbourne Parkville, Victoria, Australia
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168
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Citraro R, Leo A, De Fazio P, De Sarro G, Russo E. Antidepressants but not antipsychotics have antiepileptogenic effects with limited effects on comorbid depressive-like behaviour in the WAG/Rij rat model of absence epilepsy. Br J Pharmacol 2015; 172:3177-88. [PMID: 25754610 DOI: 10.1111/bph.13121] [Citation(s) in RCA: 38] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2014] [Revised: 01/22/2015] [Accepted: 02/21/2015] [Indexed: 12/11/2022] Open
Abstract
BACKGROUND AND PURPOSE Two of the most relevant unmet needs in epilepsy are represented by the development of disease-modifying drugs able to affect epileptogenesis and/or the study of related neuropsychiatric comorbidities. No systematic study has investigated the effects of chronic treatment with antipsychotics or antidepressants on epileptogenesis. However, such drugs are known to influence seizure threshold. EXPERIMENTAL APPROACH We evaluated the effects of an early long-term treatment (ELTT; 17 weeks), started before seizure onset (P45), with fluoxetine (selective 5-HT-reuptake inhibitor), duloxetine (dual-acting 5-HT-noradrenaline reuptake inhibitor), haloperidol (typical antipsychotic drug), risperidone and quetiapine (atypical antipsychotic drugs) on the development of absence seizures and comorbid depressive-like behaviour in the WAG/Rij rat model. Furthermore, we studied the effects of these drugs on established absence seizures in adult (6-month-old) rats after a chronic 7 weeks treatment. KEY RESULTS ELTT with all antipsychotics did not affect the development of seizures, whereas, both ELTT haloperidol (1 mg · kg(-1) day(-1)) and risperidone (0.5 mg · kg(-1) day(-1)) increased immobility time in the forced swimming test and increased absence seizures only in adult rats (7 weeks treatment). In contrast, both fluoxetine (30 mg · kg(-1) day(-1)) and duloxetine (10-30 mg · kg(-1) day(-1)) exhibited clear antiepileptogenic effects. Duloxetine decreased and fluoxetine increased absence seizures in adult rats. Duloxetine did not affect immobility time; fluoxetine 30 mg · kg(-1) day(-1) reduced immobility time while at 10 mg · kg(-1) day(-1) an increase was observed. CONCLUSIONS AND IMPLICATIONS In this animal model, antipsychotics had no antiepileptogenic effects and might worsen depressive-like comorbidity, while antidepressants have potential antiepileptogenic effects even though they have limited effects on comorbid depressive-like behaviour.
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Affiliation(s)
- Rita Citraro
- Pharmacology Unit, Science of Health Department School of Medicine and Surgery, University 'Magna Graecia' of Catanzaro, Catanzaro, Italy
| | - Antonio Leo
- Pharmacology Unit, Science of Health Department School of Medicine and Surgery, University 'Magna Graecia' of Catanzaro, Catanzaro, Italy
| | - Pasquale De Fazio
- Psichiatry Unit, Science of Health Department School of Medicine and Surgery, University 'Magna Graecia' of Catanzaro, Catanzaro, Italy
| | - Giovambattista De Sarro
- Pharmacology Unit, Science of Health Department School of Medicine and Surgery, University 'Magna Graecia' of Catanzaro, Catanzaro, Italy
| | - Emilio Russo
- Pharmacology Unit, Science of Health Department School of Medicine and Surgery, University 'Magna Graecia' of Catanzaro, Catanzaro, Italy
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169
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Mazur-Mosiewicz A, Carlson HL, Hartwick C, Dykeman J, Lenders T, Brooks BL, Wiebe S. Effectiveness of cognitive rehabilitation following epilepsy surgery: Current state of knowledge. Epilepsia 2015; 56:735-44. [DOI: 10.1111/epi.12963] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/10/2015] [Indexed: 11/28/2022]
Affiliation(s)
- Anya Mazur-Mosiewicz
- The Chicago School of Professional Psychology; Chicago Illinois U.S.A
- Alberta Children's Hospital; Calgary Alberta Canada
| | - Helen L. Carlson
- Alberta Children's Hospital; Calgary Alberta Canada
- Alberta Children's Hospital Research Institute; Calgary Alberta Canada
| | | | | | | | - Brian L. Brooks
- Alberta Children's Hospital; Calgary Alberta Canada
- Alberta Children's Hospital Research Institute; Calgary Alberta Canada
- University of Calgary; Calgary Alberta Canada
| | - Samuel Wiebe
- Foothills Medical Centre; Calgary Alberta Canada
- University of Calgary; Calgary Alberta Canada
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170
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Tavares TP, Puka K, Smith ML. Emotional functioning: Long-term outcomes after pediatric epilepsy surgery. Epilepsia 2015; 56:745-53. [DOI: 10.1111/epi.12956] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/03/2015] [Indexed: 11/27/2022]
Affiliation(s)
- Tamara P. Tavares
- Graduate Program in Neuroscience; University of Western Ontario; London Ontario Canada
- The Brain and Mind Institute; University of Western Ontario; London Ontario Canada
| | - Klajdi Puka
- Department of Psychology; The Hospital for Sick Children; Toronto Ontario Canada
| | - Mary Lou Smith
- Department of Psychology; The Hospital for Sick Children; Toronto Ontario Canada
- Department of Psychology; University of Toronto Mississauga; Mississauga Ontario Canada
- Neurosciences and Mental Health Program; The Hospital for Sick Children; Toronto Ontario Canada
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171
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Wilson SJ, Baxendale S, Barr W, Hamed S, Langfitt J, Samson S, Watanabe M, Baker GA, Helmstaedter C, Hermann BP, Smith ML. Indications and expectations for neuropsychological assessment in routine epilepsy care: Report of the ILAE Neuropsychology Task Force, Diagnostic Methods Commission, 2013-2017. Epilepsia 2015; 56:674-81. [PMID: 25779625 DOI: 10.1111/epi.12962] [Citation(s) in RCA: 108] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/10/2015] [Indexed: 11/27/2022]
Abstract
The International League Against Epilepsy (ILAE) Diagnostic Methods Commission charged the Neuropsychology Task Force with the job of developing a set of recommendations to address the following questions: (1) What is the role of a neuropsychological assessment? (2) Who should do a neuropsychological assessment? (3) When should people with epilepsy be referred for a neuropsychological assessment? and (4) What should be expected from a neuropsychological assessment? The recommendations have been broadly written for health care clinicians in established epilepsy settings as well as those setting up new services. They are based on a detailed survey of neuropsychological assessment practices across international epilepsy centers, and formal ranking of specific recommendations for advancing clinical epilepsy care generated by specialist epilepsy neuropsychologists from around the world. They also incorporate the latest research findings to establish minimum standards for training and practice, reflecting the many roles of neuropsychological assessment in the routine care of children and adults with epilepsy. The recommendations endorse routine screening of cognition, mood, and behavior in new-onset epilepsy, and describe the range of situations when more detailed, formal neuropsychological assessment is indicated. They identify a core set of cognitive and psychological domains that should be assessed to provide an objective account of an individual's cognitive, emotional, and psychosocial functioning, including factors likely contributing to deficits identified on qualitative and quantitative examination. The recommendations also endorse routine provision of feedback to patients, families, and clinicians about the implications of the assessment results, including specific clinical recommendations of what can be done to improve a patient's cognitive or psychosocial functioning and alleviate the distress of any difficulties identified. By canvassing the breadth and depth of scope of neuropsychological assessment, this report demonstrates the pivotal role played by this noninvasive and minimally resource intensive investigation in the care of people with epilepsy.
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Affiliation(s)
- Sarah J Wilson
- Melbourne School of Psychological Sciences, The University of Melbourne, Austin Health, Melbourne, Australia.,Comprehensive Epilepsy Program, Austin Health, Melbourne, Australia
| | - Sallie Baxendale
- Department of Clinical and Experimental Epilepsy, UCL Institute of Neurology, NIHR University College London Hospitals Biomedical Research Centre, London, United Kingdom
| | - William Barr
- Departments of Neurology & Psychiatry, NYU School of Medicine, New York, U.S.A
| | - Sherifa Hamed
- Department of Neurology & Psychiatry, Assiut University Hospital, Assiut, Egypt
| | - John Langfitt
- Departments of Neurology & Psychiatry, University of Rochester Medical Center, Rochester, New York, U.S.A
| | - Séverine Samson
- Epilepsy Unit, la Pitié-Salpêtrière Hospital, Paris, France.,Neuropsychology and Auditory Cognition, University Lille-Nord de France, France
| | - Masako Watanabe
- Department of Psychiatry, The National Center of Neurology & Psychiatry, Tokyo, Japan
| | - Gus A Baker
- University Department of Neurosciences, Walton Centre for Neurology and Neurosurgery, Liverpool, United Kingdom
| | | | - Bruce P Hermann
- Department of Neurology, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin, U.S.A
| | - Mary-Lou Smith
- Department of Psychology, University of Toronto Mississauga, Toronto, Canada.,Neurosciences and Mental Health Program, The Hospital for Sick Children, Toronto, Canada
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172
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Kellermann TS, Bonilha L, Lin JJ, Hermann BP. Mapping the landscape of cognitive development in children with epilepsy. Cortex 2015; 66:1-8. [PMID: 25776901 DOI: 10.1016/j.cortex.2015.02.001] [Citation(s) in RCA: 34] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2014] [Revised: 12/12/2014] [Accepted: 02/06/2015] [Indexed: 12/24/2022]
Abstract
OBJECTIVE Normal childhood development is defined by age-dependent improvement across cognitive abilities, including language, memory, psychomotor speed and executive function. Epilepsy is often associated with a global disruption in cognitive development, however, it is still largely unknown how epilepsy affects the overall organization of overlapping cognitive domains. The aim of the study was to evaluate how childhood epilepsy affects the developmental interrelationships between cognitive domains. METHODS We performed a comprehensive assessment of neuropsychological function in 127 children with new onset epilepsy and 80 typically developing children matched for age, gender, and socio-demographic status. A cross-correlation matrix between the performances across multiple cognitive tests was used to assess the interrelationship between cognitive modalities for each group (patients and controls). A weighted network composed by the cognitive domains as nodes, and pair-wise domain correlation as links, was assessed using graph theory analyses, with focus on global network structure, network hubs and community structure. RESULTS Normally developing children exhibited a cognitive network with well-defined modules, with verbal intelligence, reading and spelling skills occupying a central position in the developing network. Conversely, children with epilepsy demonstrated a less well-organized network with less clear separation between modules, and relative isolation of measures of attention and executive function. CONCLUSION Our findings demonstrate that childhood-onset epilepsy, even within its early course, is associated with an extensive disruption of cognitive neurodevelopmental organization. The approach used in this study may be useful to assess the effectiveness of future interventions aimed at mitigating the cognitive consequences of epilepsy.
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Affiliation(s)
- Tanja S Kellermann
- Department of Neurosciences, Medical University of South Carolina, Charleston, SC, USA
| | - Leonardo Bonilha
- Department of Neurosciences, Medical University of South Carolina, Charleston, SC, USA
| | - Jack J Lin
- Department of Neurology, University of California Irvine, Irvine, CA, USA
| | - Bruce P Hermann
- Department of Neurology, University of Wisconsin, Madison, WI, USA.
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173
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Abstract
Benign rolandic epilepsy (BRE), childhood idiopathic occipital epilepsy (CIOE), childhood absence epilepsy (CAE), and juvenile myoclonic epilepsy (JME) are some of the common epilepsy syndromes in the pediatric age group. Among the four, BRE is the most commonly encountered. BRE remits by age 16 years with many children requiring no treatment. Seizures in CAE also remit at the rate of approximately 80%; whereas, JME is considered a lifelong condition even with the use of antiepileptic drugs (AEDs). Neonates and infants may also present with seizures that are self-limited with no associated psychomotor disturbances. Benign familial neonatal convulsions caused by a channelopathy, and inherited in an autosomal dominant manner, have a favorable outcome with spontaneous resolution. Benign idiopathic neonatal seizures, also referred to as "fifth-day fits," are an example of another epilepsy syndrome in infants that carries a good prognosis. BRE, CIOE, benign familial neonatal convulsions, benign idiopathic neonatal seizures, and benign myoclonic epilepsy in infancy are characterized as "benign" idiopathic age-related epilepsies as they have favorable implications, no structural brain abnormality, are sensitive to AEDs, have a high remission rate, and have no associated psychomotor disturbances. However, sometimes selected patients may have associated comorbidities such as cognitive and language delay for which the term "benign" may not be appropriate.
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174
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Costa CRCMD, Oliveira GDM, Gomes MDM, Maia Filho HDS. Clinical and neuropsychological assessment of attention and ADHD comorbidity in a sample of children and adolescents with idiopathic epilepsy. ARQUIVOS DE NEURO-PSIQUIATRIA 2015; 73:96-103. [DOI: 10.1590/0004-282x20140219] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/22/2014] [Accepted: 11/07/2014] [Indexed: 11/22/2022]
Abstract
Children with epilepsy present significant problems concerning attention and comorbidity with attention deficit hyperactivity disorder (ADHD). Objective To determine the prevalence of attention complaints, ADHD diagnosis and attention profile in a sample of children and adolescents with idiopathic epilepsy. Method 36 children and adolescents with idiopathic epilepsy and 37 genre and age matched healthy controls underwent several procedures to diagnose their neuropsychological profile and comorbidity with ADHD. Results The prevalence of ADHD was higher in patients with epilepsy [χ2= 4.1, p = 0.043, 6 (16.7%) vs 1 (2.7%)], with worse results in attention related WISC items and factors in patients with epilepsy comparing to the controls, but not between patients with and without ADHD. Clinical characteristics did not influence those results. Conclusion This study found a greater prevalence of problems wih attention in pediatric patients with idiopathic epilepsy, but not a distinct profile between those with or without ADHD.
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175
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Taylor PN, Wang Y, Goodfellow M, Dauwels J, Moeller F, Stephani U, Baier G. A computational study of stimulus driven epileptic seizure abatement. PLoS One 2014; 9:e114316. [PMID: 25531883 PMCID: PMC4273970 DOI: 10.1371/journal.pone.0114316] [Citation(s) in RCA: 58] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2014] [Accepted: 11/05/2014] [Indexed: 01/24/2023] Open
Abstract
Active brain stimulation to abate epileptic seizures has shown mixed success. In spike-wave (SW) seizures, where the seizure and background state were proposed to coexist, single-pulse stimulations have been suggested to be able to terminate the seizure prematurely. However, several factors can impact success in such a bistable setting. The factors contributing to this have not been fully investigated on a theoretical and mechanistic basis. Our aim is to elucidate mechanisms that influence the success of single-pulse stimulation in noise-induced SW seizures. In this work, we study a neural population model of SW seizures that allows the reconstruction of the basin of attraction of the background activity as a four dimensional geometric object. For the deterministic (noise-free) case, we show how the success of response to stimuli depends on the amplitude and phase of the SW cycle, in addition to the direction of the stimulus in state space. In the case of spontaneous noise-induced seizures, the basin becomes probabilistic introducing some degree of uncertainty to the stimulation outcome while maintaining qualitative features of the noise-free case. Additionally, due to the different time scales involved in SW generation, there is substantial variation between SW cycles, implying that there may not be a fixed set of optimal stimulation parameters for SW seizures. In contrast, the model suggests an adaptive approach to find optimal stimulation parameters patient-specifically, based on real-time estimation of the position in state space. We discuss how the modelling work can be exploited to rationally design a successful stimulation protocol for the abatement of SW seizures using real-time SW detection.
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Affiliation(s)
- Peter Neal Taylor
- School of Computing Science, Newcastle University, Newcastle upon Tyne, United Kingdom
| | - Yujiang Wang
- School of Computing Science, Newcastle University, Newcastle upon Tyne, United Kingdom
| | - Marc Goodfellow
- College of Engineering, University of Exeter, Exeter, United Kingdom
| | - Justin Dauwels
- School of Electrical & Electronic Engineering, Nanyang Technological University, Singapore, Singapore
| | - Friederike Moeller
- Department of Neuropediatrics, University Medical Center Schleswig-Holstein, Kiel, Germany
| | - Ulrich Stephani
- Department of Neuropediatrics, University Medical Center Schleswig-Holstein, Kiel, Germany
| | - Gerold Baier
- Cell and Developmental Biology, University College London, London, United Kingdom
- * E-mail:
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176
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Abstract
Background:Most estimates of the prevalence of seizure disorders in Canada derive from national surveys which differ in sampling and case-finding methods. This study used health care utilization data to make a population-based estimate of the prevalence of epileptic seizures and of epilepsy in children in British Columbia (BC).Methods:All BC residents between 0-19 years-of-age in 2002-3 enrolled in the Medical Services Plan were included. Epileptic seizures were defined using ICD-9 codes; health care utilization data was obtained from BC Linked Health Database. The period prevalence of epileptic seizures and of epilepsy was determined by age, urban/rural region and socioeconomic status.Results:8,125 of 1,013,816 children were identified as having an epileptic seizure of which 5,621 were classified as epilepsy - 5.5 per 1,000 children (95% CI: 5.4-5.7). The prevalence of epilepsy in infants and preschoolers was higher than that reported in the literature. A higher prevalence of epilepsy was observed also among those with low socioeconomic status. A higher prevalence of epilepsy was observed in those health regions with a higher proportion of First Nations and a lower prevalence was observed in health regions with a higher proportion of visible minorities.Conclusions:Age-specific prevalence rates in BC children for epilepsy, determined from population-based administrative records, were similar to published data except in children under five years. We found a gradient of increased prevalence with decreased level of income. Prevalence rates based on utilization data have the potential to guide program planning for children with epileptic seizures.
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177
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Duran MHC, Guimarães CA, Montenegro MA, Neri ML, Guerreiro MM. ADHD in idiopathic epilepsy. ARQUIVOS DE NEURO-PSIQUIATRIA 2014; 72:12-6. [PMID: 24637976 DOI: 10.1590/0004-282x20130193] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/19/2013] [Accepted: 07/26/2013] [Indexed: 11/21/2022]
Abstract
Our aim was to clarify the correlation of attention deficit hyperactivity disorder (ADHD) with epilepsy and behavior problems. This was a cross-sectional study. Sixty children with idiopathic epilepsy were interviewed using the MTA-SNAP IV Teacher and Parent Rating Scale, Vineland Adaptive Behavior Scales and Conners' Rating Scales. We used the chi-square test to analyze the correlation of epilepsy variables in patients with and without ADHD with a significance level of 0.05. Eight patients had ADHD symptoms (13%), seven had the inattentive ADHD subtype and only three had behavioral problems. When epileptic patients with and without ADHD symptoms were compared we found no significant difference in regard to epilepsy variables. All patients were controlled and 43% were either without AED or undergoing withdrawal. Our study revealed a low comorbidity of ADHD symptoms and epilepsy due to low interference of seizures and drug treatment on the comorbid condition.
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Camfield CS, Berg A, Stephani U, Wirrell EC. Transition issues for benign epilepsy with centrotemporal spikes, nonlesional focal epilepsy in otherwise normal children, childhood absence epilepsy, and juvenile myoclonic epilepsy. Epilepsia 2014; 55 Suppl 3:16-20. [DOI: 10.1111/epi.12706] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/30/2014] [Indexed: 11/30/2022]
Affiliation(s)
- Carol S. Camfield
- Department of Pediatrics; Dalhousie University; Halifax Nova Scotia Canada
- Department of Pediatrics; IWK Health Centre; Halifax Nova Scotia Canada
| | - Anne Berg
- Epilepsy Center; Ann & Robert H. Lurie Children's Hospital of Chicago; Chicago Illinois U.S.A
| | | | - Elaine C. Wirrell
- Department of Neurology; Child and Adolescent Neurology; Mayo Clinic; Rochester Minnesota U.S.A
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179
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Are children affected by epileptic neuropsychiatric comorbidities? Epilepsy Behav 2014; 38:8-12. [PMID: 24239433 DOI: 10.1016/j.yebeh.2013.10.003] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/26/2013] [Revised: 10/01/2013] [Accepted: 10/02/2013] [Indexed: 11/22/2022]
Abstract
Childhood-onset epilepsy is associated with psychiatric and cognitive difficulties and with poor social outcomes in adulthood. Some antiepileptic drugs adversely affect behavior in susceptible children with easy-to-control or refractory epilepsies, contributing to a high risk of psychological and psychiatric disturbance. Studies had demonstrated that patients with benign rolandic epilepsy and absence epilepsy had more aggressive behavior, depression, and anxiety disorders than control children. Psychiatric comorbidities are strongly associated with a poor long-term health-related quality of life in childhood-onset epilepsy, which suggests that comprehensive epilepsy care must include screening and long-term treatment for these conditions, even if seizures remit.
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180
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Carney PW, Jackson GD. Insights into the mechanisms of absence seizure generation provided by EEG with functional MRI. Front Neurol 2014; 5:162. [PMID: 25225491 PMCID: PMC4150362 DOI: 10.3389/fneur.2014.00162] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2014] [Accepted: 08/14/2014] [Indexed: 11/20/2022] Open
Abstract
Absence seizures (AS) are brief epileptic events characterized by loss of awareness with subtle motor features. They may be very frequent, and impact on attention, learning, and memory. A number of pathophysiological models have been developed to explain the mechanism of absence seizure generation, which relies heavily on observations from animal studies. Studying the structural and functional relationships between large-scale brain networks in humans is only practical with non-invasive whole brain techniques. EEG with functional MRI (EEG-fMRI) is one such technique that provides an opportunity to explore the interactions between brain structures involved in AS generation. A number of fMRI techniques including event-related analysis, time-course analysis, and functional connectivity (FC) have identified a common network of structures involved in AS. This network comprises the thalamus, midline, and lateral parietal cortex [the default mode network (DMN)], caudate nuclei, and the reticular structures of the pons. The main component displaying an increase in blood oxygen level dependent (BOLD) signal relative to the resting state, in group studies, is the thalamus while the most consistent cortical change is reduced BOLD signal in the DMN. Time-course analysis shows that, rather than some structures being activated or inactivated during AS, there appears to be increase in activity across components of the network preceding or following the electro-clinical onset of the seizure. The earliest change in BOLD signal occurs in the DMN, prior to the onset of epileptiform events. This region also shows altered FC in patients with AS. Hence, it appears that engagement of this network is central to AS. In this review, we will explore the insights of EEG-fMRI studies into the mechanisms of AS and consider how the DMN is likely to be the major large-scale brain network central to both seizure generation and seizure manifestations.
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Affiliation(s)
- Patrick W Carney
- The Florey Institute for Neuroscience and Mental Health , Heidelberg, VIC , Australia ; The University of Melbourne , Parkville, VIC , Australia ; Austin Health , Heidelberg, VIC , Australia
| | - Graeme D Jackson
- The Florey Institute for Neuroscience and Mental Health , Heidelberg, VIC , Australia ; The University of Melbourne , Parkville, VIC , Australia ; Austin Health , Heidelberg, VIC , Australia
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181
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Rathouz PJ, Zhao Q, Jones JE, Jackson DC, Hsu DA, Stafstrom CE, Seidenberg M, Hermann BP. Cognitive development in children with new onset epilepsy. Dev Med Child Neurol 2014; 56:635-41. [PMID: 24650092 PMCID: PMC4057956 DOI: 10.1111/dmcn.12432] [Citation(s) in RCA: 53] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 12/30/2013] [Indexed: 11/28/2022]
Abstract
AIM To characterize the prospective trajectory of cognitive development in children with new or recent onset epilepsy from baseline to 5 to 6 years after diagnosis. METHOD Sixty-nine children (40 males, 29 females; age 8-18y), with new or recent onset epilepsies underwent neuropsychological assessment shortly after diagnosis (Wave 1), 2 years (Wave 2), and 5 to 6 years after diagnosis (Wave 3). Intelligence, academic achievement, language, executive function, and psychomotor speed were evaluated. Sixty-two children (28 males, 34 females; age 8-18) with typical development served as a comparison group at each time point. The cognitive data were examined by syndrome (localization-related epilepsy [LRE]; idiopathic generalized epilepsy [IGE]; comparison group). Mixed effect regression models compared trajectories among groups with respect to time since diagnosis. RESULTS Cognitive abnormalities exhibited by children with epilepsy in arithmetic computation, response inhibition, attention, fine motor dexterity, and psychomotor speed (all p values <0.001), are detectable at or near the time of diagnosis and largely remain stable over the ensuing 5 to 6 years without evidence of progressive worsening or recovery. This course is evident across both LRE and IGE groups, with the LRE group performing better for some outcomes (arithmetic, response inhibition, psychomotor speed) and never worse than the IGE group. INTERPRETATION Cognitive development in children with LRE and IGE is not characterized by progressive deterioration or lack of age-appropriate development; rather, development lags behind that of children with typical development. Cognitive abnormalities, when detected, are present near the time of diagnosis, persist over time, and require early intervention.
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Affiliation(s)
- Paul J Rathouz
- Department of Biostatistics & Medical Informatics, University of Wisconsin School of Medicine and Public Health
| | - Qianqian Zhao
- Department of Biostatistics & Medical Informatics, University of Wisconsin School of Medicine and Public Health
| | - Jana E Jones
- Department of Neurology, University of Wisconsin School of Medicine and Public Health, Madison, WI
| | - Daren C Jackson
- Department of Neurology, University of Wisconsin School of Medicine and Public Health, Madison, WI
| | - Dave A Hsu
- Department of Neurology, University of Wisconsin School of Medicine and Public Health, Madison, WI
| | - Carl E Stafstrom
- Department of Neurology, University of Wisconsin School of Medicine and Public Health, Madison, WI
| | - Michael Seidenberg
- Department of Psychology, Rosalind Franklin University, North Chicago, IL, USA
| | - Bruce P Hermann
- Department of Neurology, University of Wisconsin School of Medicine and Public Health, Madison, WI
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Compromised maturation of GABAergic inhibition underlies abnormal network activity in the hippocampus of epileptic Ca2+ channel mutant mice, tottering. Pflugers Arch 2014; 467:737-52. [DOI: 10.1007/s00424-014-1555-6] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2014] [Revised: 06/09/2014] [Accepted: 06/10/2014] [Indexed: 10/25/2022]
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183
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Verrotti A, Carrozzino D, Milioni M, Minna M, Fulcheri M. Epilepsy and its main psychiatric comorbidities in adults and children. J Neurol Sci 2014; 343:23-9. [PMID: 24929650 DOI: 10.1016/j.jns.2014.05.043] [Citation(s) in RCA: 49] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2014] [Revised: 05/08/2014] [Accepted: 05/19/2014] [Indexed: 12/11/2022]
Abstract
Psychiatric disorders seem to be more frequent in patients with epilepsy (PWE) than the general population. Although researchers have documented a strong association between epilepsy and psychiatric comorbidities, the nature of this relationship is poorly understood. According to this, psychiatric diseases are often underdiagnosed and undertreated in PWE with further decrease of the quality of life of patients. The aim of the review was to examine the most frequent psychiatric comorbidities in adults with epilepsy (AWE) and the main psychiatric comorbidities in children with epilepsy (CWE) in order to better understand the relationship between epilepsy and the development of psychiatric disorders.
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Affiliation(s)
- Alberto Verrotti
- Department of Pediatrics, University of Perugia, Piazza Università 1, Perugia 06123, Italy.
| | - Danilo Carrozzino
- Department of Clinical and Experimental Sciences, School of Advanced Studies, "G. D'Annunzio" University of Chieti-Pescara, Via dei Vestini 31, Chieti 66013, Italy
| | - Maddalena Milioni
- Department of Pediatrics, University of Perugia, Piazza Università 1, Perugia 06123, Italy
| | - Maria Minna
- Department of Clinical and Experimental Sciences, School of Advanced Studies, "G. D'Annunzio" University of Chieti-Pescara, Via dei Vestini 31, Chieti 66013, Italy
| | - Mario Fulcheri
- Department of Psychological, Humanistic and Territorial Sciences, University "G. D'Annunzio" of Chieti-Pescara, Via dei Vestini 31, Chieti 66013, Italy
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185
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Jonsson P, Jonsson B, Eeg-Olofsson O. Psychological and social outcome of epilepsy in well-functioning children and adolescents. A 10-year follow-up study. Eur J Paediatr Neurol 2014; 18:381-90. [PMID: 24565749 DOI: 10.1016/j.ejpn.2014.01.010] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/16/2013] [Revised: 12/17/2013] [Accepted: 01/26/2014] [Indexed: 11/30/2022]
Abstract
BACKGROUND From a population based study of epilepsy in Swedish children a subgroup designated well-functioning with an epilepsy diagnosis in 1997 was worked up from a medical point of view 10 years later. AIM To describe the psychological and social outcome in this subgroup. METHODS Thirty-one patients aged 11-22 years and their parents/partners responded to a questionnaire according to Achenbach System of Empirically Based Assessment (ASEBA) to evaluate behavioural and emotional problems, and social competence. RESULTS Active epilepsy, diagnosed in 32%, was related to attention problems, somatic complaints, and school problems. Polytherapy, used in 16%, was related to attention problems and aggressive behaviour. School problems were found in six of seven children younger than 18 years. Internalizing, externalizing, and 'other' syndromes were found in 29% of the individuals, but a grouping of these syndromes in the clinical range only in two (6.5%), a girl with generalized tonic-clonic seizures alone, and a boy with structural focal epilepsy. Both had active epilepsy and were treated with polytherapy. All ten individuals with Rolandic epilepsy were classified as normal. The answers to the ASEBA questionnaire of individuals and parents/partners were inconsistent, and parents generally stated more problems than the individuals. SUMMARY This 10-year follow-up study of psychological and social outcome in well-functioning children and adolescents with childhood onset epilepsy shows some emotional, behavioural, and social problems. Thus, early information to increase knowledge about epilepsy and associated psychological co-morbidities in order to decrease risk of low self-esteem, social anxiety, and depression later in life is of importance.
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Affiliation(s)
- Pysse Jonsson
- Department of Women's and Children's Health, Neuropaediatrics, Uppsala University, Uppsala, Sweden.
| | - Björn Jonsson
- Department of Women's and Children's Health, Neuropaediatrics, Uppsala University, Uppsala, Sweden
| | - Orvar Eeg-Olofsson
- Department of Women's and Children's Health, Neuropaediatrics, Uppsala University, Uppsala, Sweden
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Luo C, Yang T, Tu S, Deng J, Liu D, Li Q, Dong L, Goldberg I, Gong Q, Zhang D, An D, Zhou D, Yao D. Altered intrinsic functional connectivity of the salience network in childhood absence epilepsy. J Neurol Sci 2014; 339:189-95. [DOI: 10.1016/j.jns.2014.02.016] [Citation(s) in RCA: 38] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2013] [Revised: 01/29/2014] [Accepted: 02/17/2014] [Indexed: 11/25/2022]
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188
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Paying Attention to School Achievement in Childhood Absence Epilepsy. Epilepsy Curr 2014; 14:68-70. [DOI: 10.5698/1535-7597-14.2.68] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
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189
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Matricardi S, Verrotti A, Chiarelli F, Cerminara C, Curatolo P. Current advances in childhood absence epilepsy. Pediatr Neurol 2014; 50:205-12. [PMID: 24530152 DOI: 10.1016/j.pediatrneurol.2013.10.009] [Citation(s) in RCA: 46] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/20/2013] [Revised: 10/06/2013] [Accepted: 10/12/2013] [Indexed: 11/19/2022]
Abstract
BACKGROUND Childhood absence epilepsy is an age-dependent, idiopathic, generalized epilepsy with a characteristic seizure appearance. The disorder is likely to be multifactorial, resulting from interactions between genetic and acquired factors, but the debate is still open. We review recent studies on different aspects of childhood absence epilepsy and also to describe new concepts. METHODS Data for this review were identified using Medline and PubMed survey to locate studies dealing with childhood absence epilepsy. Searches included articles published between 1924 and 2013. RESULTS The diagnosis comprises predominant and associated seizure types associated with other clinical and electroencephalographic characteristics. Many studies have challenged the prevailing concepts, particularly with respect to the pathophysiological mechanisms underlying the electroencephalographic seizure discharges. Childhood absence epilepsy fits the definition of system epilepsy as a condition resulting from the persisting susceptibility of the thalamocortical system as a whole to generate seizures. This syndrome, if properly defined using strict diagnostic criteria, has a good prognosis. In some cases, it may affect multiple cognitive functions determining risk for academic and functional difficulties; the detection of children at risk allows tailored interventions. Childhood absence epilepsy is usually treated with ethosuximide, valproate, lamotrigine, or levetiracetam, but the most efficacious and tolerable initial empirical treatment has not been well defined. CONCLUSIONS We review recent studies and new concepts on the electroclinical features and pathophysiological findings of childhood absence epilepsy in order to highlight areas of consensus as well as areas of uncertainty that indicate directions for future research.
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Affiliation(s)
- Sara Matricardi
- Department of Pediatrics, University "G. D'Annunzio" of Chieti, Chieti, Italy.
| | | | - Francesco Chiarelli
- Department of Pediatrics, University "G. D'Annunzio" of Chieti, Chieti, Italy
| | - Caterina Cerminara
- Department of Neurosciences, Pediatric Neurology Unit Tor Vergata University, Rome, Italy
| | - Paolo Curatolo
- Department of Neurosciences, Pediatric Neurology Unit Tor Vergata University, Rome, Italy
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Yang T, Fang Z, Ren J, Xiao F, Li Q, Liu L, Lei D, Gong Q, Zhou D. Altered spontaneous activity in treatment-naive childhood absence epilepsy revealed by Regional Homogeneity. J Neurol Sci 2014; 340:58-62. [PMID: 24746024 DOI: 10.1016/j.jns.2014.02.025] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2013] [Revised: 02/17/2014] [Accepted: 02/21/2014] [Indexed: 02/05/2023]
Abstract
PURPOSE To explore the differences in regional spontaneous activities throughout the whole brain by the Regional Homogeneity (ReHo) method in untreated childhood absence epilepsy (CAE), in order to understand the neuro-pathophysiological mechanism of function impairments in CAE. METHODS The rest-functional MRI was used to measure the ReHo in 16 patients with untreated CAE and 16 age- and sex-matched healthy controls. The correlations between the ReHo at each voxel of the whole brain and duration of epilepsy were analyzed. RESULTS Compared with healthy controls, we found that ReHo was decreased in bilateral thalamus, caudate, posterior lobe of cerebellum and areas mainly in the default mode network (DMN) (including precuneus and posterior cingulate cortex-PCC, bilateral inferior lateral parietal lobule). The increase of ReHo was found in bilateral insula, left occipital cortex. Moreover, a correlation analysis of the ReHo measurement versus the epilepsy duration was performed, and highly positive correlation was observed in precuneus/PCC and supplementary motor area (SMA). SIGNIFICANCE The current findings demonstrated alterations of ReHo in the striato-thalamo-cortical network in drug naïve CAE subjects during interictal resting state. Some regions with decreased ReHo followed the pattern of 'default' state of brain function. In addition, positive correlations between the ReHo values in the precuneus/PCC and SMA and the disease duration were identified. These results indicate that the involvement of these regions may be related to the pathomechanisms of seizure generation and the neurological deficits observed in CAE patients. ReHo has demonstrated the capability to characterize spontaneous brain dysfunction in epilepsy.
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Affiliation(s)
- Tianhua Yang
- Department of Neurology, West China Hospital, Sichuan University, Cheng du, PR China
| | - Zhijia Fang
- Huaxi MR Research Center (HMRRC), Department of Radiology, West China Hospital of Sichuan University, PR China
| | - Jiechuan Ren
- Department of Neurology, West China Hospital, Sichuan University, Cheng du, PR China
| | - Fenglai Xiao
- Department of Neurology, West China Hospital, Sichuan University, Cheng du, PR China
| | - Qifu Li
- Department of Neurology, The Affiliated Hospital of Hainan Medical College, Haikou, PR China
| | - Ling Liu
- Department of Neurology, West China Hospital, Sichuan University, Cheng du, PR China
| | - Du Lei
- Huaxi MR Research Center (HMRRC), Department of Radiology, West China Hospital of Sichuan University, PR China
| | - Qiyong Gong
- Huaxi MR Research Center (HMRRC), Department of Radiology, West China Hospital of Sichuan University, PR China.
| | - Dong Zhou
- Department of Neurology, West China Hospital, Sichuan University, Cheng du, PR China.
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Faure JB, Marques-Carneiro JE, Akimana G, Cosquer B, Ferrandon A, Herbeaux K, Koning E, Barbelivien A, Nehlig A, Cassel JC. Attention and executive functions in a rat model of chronic epilepsy. Epilepsia 2014; 55:644-653. [PMID: 24621352 DOI: 10.1111/epi.12549] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/03/2014] [Indexed: 11/30/2022]
Abstract
OBJECTIVE Temporal lobe epilepsy is a relatively frequent, invalidating, and often refractory neurologic disorder. It is associated with cognitive impairments that affect memory and executive functions. In the rat lithium-pilocarpine temporal lobe epilepsy model, memory impairment and anxiety disorder are classically reported. Here we evaluated sustained visual attention in this model of epilepsy, a function not frequently explored. METHODS Thirty-five Sprague-Dawley rats were subjected to lithium-pilocarpine status epilepticus. Twenty of them received a carisbamate treatment for 7 days, starting 1 h after status epilepticus onset. Twelve controls received lithium and saline. Five months later, attention was assessed in the five-choice serial reaction time task, a task that tests visual attention and inhibitory control (impulsivity/compulsivity). Neuronal counting was performed in brain regions of interest to the functions studied (hippocampus, prefrontal cortex, nucleus basalis magnocellularis, and pedunculopontine tegmental nucleus). RESULTS Lithium-pilocarpine rats developed motor seizures. When they were able to learn the task, they exhibited attention impairment and a tendency toward impulsivity and compulsivity. These disturbances occurred in the absence of neuronal loss in structures classically related to attentional performance, although they seemed to better correlate with neuronal loss in hippocampus. Globally, rats that received carisbamate and developed motor seizures were as impaired as untreated rats, whereas those that did not develop overt motor seizures performed like controls, despite evidence for hippocampal damage. SIGNIFICANCE This study shows that attention deficits reported by patients with temporal lobe epilepsy can be observed in the lithium-pilocarpine model. Carisbamate prevents the occurrence of motor seizures, attention impairment, impulsivity, and compulsivity in a subpopulation of neuroprotected rats.
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Affiliation(s)
- Jean-Baptiste Faure
- Laboratory of Cognitive and Adaptive Neuroscience (LNCA), Faculty of Psychology, UMR 7364 University of Strasbourg - CNRS, Strasbourg, France; Faculty of Medicine, INSERM U 666, Strasbourg, France
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Paolicchi JM. The timing of pediatric epilepsy syndromes: what are the developmental triggers? Ann N Y Acad Sci 2014; 1304:45-51. [PMID: 24279892 DOI: 10.1111/nyas.12307] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
Pediatric epilepsy is characterized by multiple epilepsy syndromes with specific developmental triggers. They initiate spontaneously at critical periods of development and can just as spontaneously remit. Accompanying neurocognitive disabilities are often specific to the epileptic syndrome. Infantile or epileptic spasms have a very specific developmental window in the first year of life. Preceding the epilepsy, developmental arrest is common. The neurologic pathways underlying the development of spasms have been identified through PET scans as developmental abnormalities of serotonergic and GABAergic neurotransmitter systems in the brain stem and basal ganglia. Childhood absence epilepsy (CAE) and benign centrotemporal epilepsy syndrome (BECTS) are both known genetic epilepsy syndromes; they have a discrete onset in childhood with remission by puberty. In CAE, disturbances of specific calcium channels at key developmental stages lead to aberrant disruption of thalamocortical synchrony. Similarly, a complex interplay between brain development, maturation, and susceptibility genes underlies the seizures and the neurocognitive deficits of BECTS.
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193
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Miao A, Tang L, Xiang J, Guan Q, Ge H, Liu H, Wu T, Chen Q, Yang L, Lu X, Hu Z, Wang X. Dynamic magnetic source imaging of absence seizure initialization and propagation: a magnetoencephalography study. Epilepsy Res 2014; 108:468-80. [PMID: 24534760 DOI: 10.1016/j.eplepsyres.2014.01.006] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2013] [Revised: 11/20/2013] [Accepted: 01/14/2014] [Indexed: 11/28/2022]
Abstract
PURPOSE The present study aims to determine the initialization and propagation of typical absence seizures using magnetoencephalography (MEG). METHOD Fourteen drug-naïve children with childhood absence epilepsy (CAE) were studied using a 275-Channel MEG system. The spectral signatures of epileptic activity were assessed using Morlet continuous wavelet transform. Magnetic sources were volumetrically localized using dynamic magnetic source imaging (dMSI) with a slide window at a millisecond temporal resolution. RESULT The initial portion of ictal activity was predominantly located to the left frontal and posterior cortices. The frontal sources were in the left medial prefrontal cortex (MPFC), the pre-supplementary motor area (pre-SMA), the primary motor cortex, and the lateral prefrontal cortex. The posterior cortical sources were predominantly localized to the left precuneus (pC) and the medial occipital cortices (MOC). The ictal activity after the initialization showed involvement of the MPFC and pC of all patients (14/14) and recursive propagation between the frontal (MPFC) and posterior cortices (pC and MOC) via either the medial portion of the brain (9/14) or the thalamus (5/14), respectively. CONCLUSION The left frontal and posterior (pC and MOC) cortices play a key role in the initialization of epileptic activity in absence seizures. The thalamus plays a key role in the propagation of absence seizures between the frontal and posterior cortical sources. Considering the MPFC and pC are the nodes of the default mode network (DMN), our results support involvement of the DMN in absence seizures.
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Affiliation(s)
- Ailiang Miao
- Department of Neurology, Nanjing Brain Hospital, Nanjing Medical University, Nanjing, Jiangsu 210029, China
| | - Lu Tang
- Department of Neurology, Nanjing Brain Hospital, Nanjing Medical University, Nanjing, Jiangsu 210029, China
| | - Jing Xiang
- MEG Center, Division of Neurology, Cincinnati Children's Hospital Medical Center, 3333 Burnet Avenue, Cincinnati, OH, 45220, USA
| | - Qingshan Guan
- Department of Neurology, Nanjing Brain Hospital, Nanjing Medical University, Nanjing, Jiangsu 210029, China
| | - Huaiting Ge
- Department of Neurology, Nanjing Brain Hospital, Nanjing Medical University, Nanjing, Jiangsu 210029, China
| | - Hongxing Liu
- Department of Neurology, Nanjing Brain Hospital, Nanjing Medical University, Nanjing, Jiangsu 210029, China
| | - Ting Wu
- MEG Center, Nanjing Brain Hospital, Nanjing, Jiangsu 210029, China
| | - Qiqi Chen
- MEG Center, Nanjing Brain Hospital, Nanjing, Jiangsu 210029, China
| | - Lu Yang
- MEG Center, Nanjing Brain Hospital, Nanjing, Jiangsu 210029, China
| | - Xiaopeng Lu
- Department of Neurology, Nanjing Children's Hospital, Nanjing, Jiangsu 210029, China
| | - Zheng Hu
- Department of Neurology, Nanjing Children's Hospital, Nanjing, Jiangsu 210029, China
| | - Xiaoshan Wang
- Department of Neurology, Nanjing Brain Hospital, Nanjing Medical University, Nanjing, Jiangsu 210029, China.
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Xue K, Luo C, Zhang D, Yang T, Li J, Gong D, Chen L, Medina YI, Gotman J, Zhou D, Yao D. Diffusion tensor tractography reveals disrupted structural connectivity in childhood absence epilepsy. Epilepsy Res 2014; 108:125-38. [PMID: 24246142 DOI: 10.1016/j.eplepsyres.2013.10.002] [Citation(s) in RCA: 64] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2012] [Revised: 09/01/2013] [Accepted: 10/13/2013] [Indexed: 10/26/2022]
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Phillips AM, Kim T, Vargas E, Petrou S, Reid CA. Spike-and-wave discharge mediated reduction in hippocampal HCN1 channel function associates with learning deficits in a genetic mouse model of epilepsy. Neurobiol Dis 2013; 64:30-5. [PMID: 24368169 DOI: 10.1016/j.nbd.2013.12.007] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2013] [Revised: 11/22/2013] [Accepted: 12/13/2013] [Indexed: 01/18/2023] Open
Abstract
The GABAAγ2(R43Q) mouse is an established model of absence epilepsy displaying spontaneous spike-and-wave discharges (SWD) and associated behavioral arrest. Absence epilepsy typically results from cortico-thalamic networks. Nevertheless, there is increasing evidence for changes in hippocampal metabolism and electrical behavior, consistent with a link between absence seizures and hippocampus-related co-morbidities. Hyperpolarization-activated-cyclic-nucleotide-gated (HCN) channels are known to be transcriptionally regulated in a number of seizure models. Here we investigate the expression and function of these channels in the hippocampus of the genetic epilepsy model. A reduction in HCN1, but not HCN2 transcript, was observed in GABAAγ2(R43Q) mice relative to their littermate controls. In contrast, no change in HCN1 transcript was noted at an age prior to seizure expression or in a SWD-free model in which the R43Q mutation has been crossed into a seizure-resistant genetic background. Whole-cell recordings from CA1 pyramidal neurons confirm a reduction in Ih in the GABAAγ2(R43Q) mouse. Further, a left-shift in half-activation of the Ih conductance-voltage relationship is consistent with a reduction in HCN1 with no change in HCN2 channel expression. Behavioral analysis using the Morris water maze indicates that GABAAγ2(R43Q) mice are unable to learn as effectively as their wildtype littermates suggesting a deficit in hippocampal-based learning. SWD-free mice harboring the R43Q mutation had no learning deficit. We conclude that SWDs reduce hippocampal HCN1 expression and function, and that the reduction associates with a spatial learning deficit.
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Affiliation(s)
- A Marie Phillips
- Florey Institute of Neuroscience and Mental Health, The University of Melbourne, Parkville 3010, Australia; Department of Genetics, University of Melbourne, Parkville 3010, Australia.
| | - Taehwan Kim
- Florey Institute of Neuroscience and Mental Health, The University of Melbourne, Parkville 3010, Australia; Centre for Neural Engineering, The University of Melbourne, Parkville 3010, Melbourne, Australia.
| | - Ernesto Vargas
- Florey Institute of Neuroscience and Mental Health, The University of Melbourne, Parkville 3010, Australia.
| | - Steven Petrou
- Florey Institute of Neuroscience and Mental Health, The University of Melbourne, Parkville 3010, Australia; Centre for Neural Engineering, The University of Melbourne, Parkville 3010, Melbourne, Australia; Department of Anatomy and Neuroscience, The University of Melbourne, Parkville 3010, Melbourne, Australia.
| | - Christopher A Reid
- Florey Institute of Neuroscience and Mental Health, The University of Melbourne, Parkville 3010, Australia.
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196
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Dragoumi P, Tzetzi O, Vargiami E, Pavlou E, Krikonis K, Kontopoulos E, Zafeiriou DI. Clinical course and seizure outcome of idiopathic childhood epilepsy: determinants of early and long-term prognosis. BMC Neurol 2013; 13:206. [PMID: 24350775 PMCID: PMC3878358 DOI: 10.1186/1471-2377-13-206] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2013] [Accepted: 11/07/2013] [Indexed: 01/20/2023] Open
Abstract
BACKGROUND Idiopathic epilepsies and epileptic syndromes predominate childhood and adolescence epilepsy. The aim of the present study was to investigate the clinical course and outcome of idiopathic childhood epilepsy and identify variables determining both early and long-term prognosis. METHODS We followed 303 children with newly diagnosed idiopathic epilepsy aged 1-14 years old, both prospectively and retrospectively. Outcome was defined at one, 2 and 4 years of follow-up, as well as at the end of the study period for all patients. Based on the data collected, patients were classified in four patterns of clinical course: "excellent", "improving", "relapsing" and "poor". Variables defined at intake and after the initial year of treatment were analyzed for their prognostic relevance towards the clinical course and outcome of the patients. RESULTS The mean age at seizure onset was 6.7 years and the mean duration of follow-up was 8.3 years (range 2,0-22,0,SD 4,24). During the initial year of treatment, 70,3% of patients were seizure-free. The course of epilepsy was "excellent" in 53,1% of the subjects, "improving" in 22,8%, "relapsing" in 22,1% whereas only 6 children with idiopathic epilepsy (2%) had a "poor" clinical course exhibiting drug-resistance. After multivariate analysis, variables predictive of a poor initial response to therapy were early seizure onset, multiple seizure types and history of status epilepticus. At the end of follow-up, early response to treatment was of significant positive predictive value, while the presence of multiple seizure types and the history of migraine had a negative impact on prognosis. CONCLUSIONS In the vast majority of children, the long-term prognosis of idiopathic epilepsy is favorable. More than half of the patients attain seizure freedom immediately and their clinical course is considered "excellent". About one fifth exhibit either an improving or a fluctuating course. Early seizure onset, multiple seizure types and status epilepticus are predictive of an initial poor response to treatment in children with idiopathic epilepsy. Initial non-response to treatment, multiple seizure types and history of migraine are determinants of a less favorable final outcome after long-term follow-up.
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Affiliation(s)
| | | | | | | | | | | | - Dimitrios I Zafeiriou
- Department of Pediatrics, Aristotle University of Thessaloniki, Hippokration General Hospital, Thessaloniki, Greece.
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Jones JE, Siddarth P, Gurbani S, Shields WD, Caplan R. Screening for suicidal ideation in children with epilepsy. Epilepsy Behav 2013; 29:521-6. [PMID: 24128934 PMCID: PMC4079123 DOI: 10.1016/j.yebeh.2013.09.020] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/14/2013] [Revised: 09/12/2013] [Accepted: 09/15/2013] [Indexed: 10/26/2022]
Abstract
Given the FDA's warning regarding the potential connection between suicidal behavior and antiepileptic drugs, this study examined methods by which to detect suicidal ideation in children with epilepsy. It compared the sensitivity, specificity, and area under the curve for identifying children with suicidal behavior using the Child Behavior Checklist (CBCL) and a structured psychiatric interview. Parent-completed CBCLs provided behavioral problem scores on 177 children with epilepsy, aged 5-16years. Psychiatric diagnoses were made based on separate child and parent structured psychiatric interviews about the child. The children answered questions on suicidal behaviors during the interview. A clinically elevated score in the CBCL Total Problems scale and having more than one psychiatric diagnosis, irrespective of the type of diagnosis, were significant predictors and correctly classified children with suicidal ideation in 79% of the cases based on the CBCL and 80% of the cases with more than one psychiatric diagnosis. These findings indicate that elevated CBCL Total Problems scores, a commonly used instrument, can screen and identify risk for suicidal behavior in children with epilepsy. Additionally, irrespective of diagnosis, if a child with epilepsy has more than one psychiatric diagnosis, further assessment of suicidal behavior is warranted. Importantly, the results underscore the utility of having parents complete a questionnaire in the waiting room in order to identify children with epilepsy at risk for suicidal behavior.
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Affiliation(s)
- Jana E. Jones
- Department of Neurology, University of Wisconsin School of Medicine and Public Health, 1685 Highland Avenue, Rm 7229 Madison, WI 53705,
| | - Prabha Siddarth
- Semel Institute for Neuroscience and Human Behavior, UCLA, Box 951759, 37-357, Los Angeles, CA 90095-1759
| | - Suresh Gurbani
- Department of Pediatrics, University of California-Irvine, Irvine, CA 900095-1752
| | - W. Donald Shields
- Department of Pediatrics, University of California Los Angeles, BOX 951752, 22-474 MDCC, Los Angeles, CA 90095-1752
| | - Rochelle Caplan
- Semel Institute for Neuroscience and Human Behavior, UCLA, 760 Westwood Plaza, Rm. 48-226 Los Angeles, CA 90095-1759
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Kadish NE, Baumann M, Pietz J, Schubert-Bast S, Reuner G. Validation of a screening tool for attention and executive functions (EpiTrack Junior) in children and adolescents with absence epilepsy. Epilepsy Behav 2013; 29:96-102. [PMID: 23939033 DOI: 10.1016/j.yebeh.2013.06.004] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/05/2013] [Revised: 06/04/2013] [Accepted: 06/07/2013] [Indexed: 11/08/2022]
Abstract
OBJECTIVE Our prospective study aimed at the validation of EpiTrack Junior, a neuropsychological screening tool for attention and executive functions in children with epilepsy. METHODS Twenty-two children with absence epilepsy aged 8-17 years underwent comprehensive neuropsychological evaluation including EpiTrack Junior and measures of intelligence, verbal and nonverbal memory, word fluency and visuoconstructive organization. Concurrent and discriminant validity of EpiTrack Junior subtests and total score as well as sensitivity and specificity of the total score were analyzed. RESULTS EpiTrack Junior total score was impaired in 59% of participants. Concurrent validity was demonstrated in 4/6 subtests and for the total score. Discriminant validity was shown with respect to verbal and nonverbal long-term memory. Sensitivity was higher than specificity and highest for the "working memory index". CONCLUSION EpiTrack Junior is recommended as a sensitive and time-efficient screening tool for attention and executive functions in children with epilepsy. Impaired results should be followed up with detailed evaluation including information from the parents and school as well as counseling where indicated.
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Affiliation(s)
- Navah Ester Kadish
- Center for Child and Adolescent Medicine, Section Neuropediatrics, University Hospital Heidelberg, Germany.
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199
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Dabbs K, Jones JE, Jackson DC, Seidenberg M, Hermann BP. Patterns of cortical thickness and the Child Behavior Checklist in childhood epilepsy. Epilepsy Behav 2013; 29:198-204. [PMID: 23978342 PMCID: PMC3795419 DOI: 10.1016/j.yebeh.2013.07.008] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/27/2013] [Revised: 07/05/2013] [Accepted: 07/07/2013] [Indexed: 10/26/2022]
Abstract
The purpose of this investigation was to characterize the neuroanatomical correlates (cortical thickness) of variations in parent-reported Child Behavior Checklist (CBCL) scores. Ninety children with epilepsy (aged 8-18) underwent brain MRI, and their parents completed the CBCL. FreeSurfer-derived measures of cortical thickness were examined in relation to the CBCL broad and narrow band competence and behavioral problem scales, as well as the newer DSM-oriented scales. Parent reports of higher (better) social competence skills were associated with increased cortical thickness, especially in frontal regions. Parent reports of behavioral problems were associated with patterns of decreased cortical thickness that varied as a function of the specific behavioral issue under investigation. Congruence of patterns of cortical thinning between the DSM-oriented scales and conceptually related specific problem scales (e.g., ADHD Problems and Attention Problems) was generally weak. The parent-report version of the CBCL is associated with variations in cortical thickness among children with epilepsy. Anatomic abnormalities specific to selected competence and behavioral problem scales can be identified, with more reliable and robust patterns of thinning across scales assessing externalizing behaviors, with generally less prominent findings on scales assessing internalizing behaviors.
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Affiliation(s)
- Kevin Dabbs
- Department of Neurology, University of Wisconsin School of Medicine and Public Health, Madison, WI, USA.
| | - Jana E. Jones
- Department of Neurology, University of Wisconsin School of Medicine and Public Health, Madison WI
| | - Daren C. Jackson
- Department of Neurology, University of Wisconsin School of Medicine and Public Health, Madison WI
| | - Michael Seidenberg
- Department of Psychology, Rosalind Franklin School of Medicine and Science, North Chicago IL
| | - Bruce P. Hermann
- Department of Neurology, University of Wisconsin School of Medicine and Public Health, Madison WI
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Lopes AF, Simões MR, Monteiro JP, Fonseca MJ, Martins C, Ventosa L, Lourenço L, Robalo C. Intellectual functioning in children with epilepsy: frontal lobe epilepsy, childhood absence epilepsy and benign epilepsy with centro-temporal spikes. Seizure 2013; 22:886-92. [PMID: 23992789 DOI: 10.1016/j.seizure.2013.08.002] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2013] [Revised: 07/26/2013] [Accepted: 08/04/2013] [Indexed: 10/26/2022] Open
Abstract
PURPOSE The purpose of our study is to describe intellectual functioning in three common childhood epilepsy syndromes - frontal lobe epilepsy (FLE), childhood absence epilepsy (CAE) and benign epilepsy with centro-temporal spikes (BECTS). And also to determine the influence of epilepsy related variables, type of epilepsy, age at epilepsy onset, duration and frequency of epilepsy, and treatment on the scores. METHODS Intellectual functioning was examined in a group of 90 children with epilepsy (30 FLE, 30 CAE, 30 BECTS), aged 6-15 years, and compared with a control group (30). All subjects obtained a Full Scale IQ ≥ 70 and they were receiving no more than two antiepileptic medications. Participants completed the Wechsler Intelligence Scale for Children - Third Edition. The impact of epilepsy related variables (type of epilepsy, age at epilepsy onset, duration of epilepsy, seizure frequency and anti-epileptic drugs) on intellectual functioning was examined. RESULTS Children with FLE scored significantly worse than controls on WISC-III Verbal IQ, Full Scale IQ and Processing Speed Index. There was a trend for children with FLE to have lower intelligence scores than CAE and BECTS groups. Linear regression analysis showed no effect for age at onset, frequency of seizures and treatment. Type of epilepsy and duration of epilepsy were the best indicators of intellectual functioning. CONCLUSION It is crucial that children with FLE and those with a longer active duration of epilepsy are closely monitored to allow the early identification and evaluation of cognitive problems, in order to establish adequate and timely school intervention plans.
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Affiliation(s)
- Ana Filipa Lopes
- Faculty of Psychology, University of Coimbra, Coimbra, Portugal; Neuropaediatric Unit - Garcia de Orta Hospital, Almada, Portugal.
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